Provider Demographics
NPI:1104424886
Name:DUNCAN, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SHALLOWFORD TRCE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4631
Mailing Address - Country:US
Mailing Address - Phone:540-808-8788
Mailing Address - Fax:
Practice Address - Street 1:1807 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4020
Practice Address - Country:US
Practice Address - Phone:804-477-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305212277OtherCOMMONWEALTH OF VIRGINIA DPT. OR HEALTH PROFESSIONALS